Angiotensin II (Giapreza)_Dosage, benefits & legal status
Also known as Giapreza, LJPC-501, angiotensin II acetate
A synthetic copy of the 8-residue hormone angiotensin II. FDA-approved in 2017 for shock that persists despite fluids and other drugs.
Common vial size is what vendors typically sell, not a recommendation. Enter your own vial in the calculator.
What is Angiotensin II (Giapreza)?
Plain language first. The technical label stays, but it never stands alone.Overview
In septic and other distributive shock, blood vessels relax so much that blood pressure collapses despite fluids and standard drugs. In the ATHOS-3 trial (321 patients treated), adding angiotensin II had blood pressure on target at 3 hours in 70% against 23% on placebo. Deaths at 28 days were 46% against 54%, a difference that could be chance. It raises the risk of blood clots, so clot-prevention treatment is given alongside.
Angiotensin II is the eight-residue end product of the renin-angiotensin system (Asp-Arg-Val-Tyr-Ile-His-Pro-Phe), made synthetically and given as the acetate salt. It activates AT1 receptors on blood-vessel muscle, narrowing vessels and raising blood pressure, and stimulates aldosterone release from the adrenal glands. La Jolla Pharmaceutical developed it as LJPC-501; Innoviva has owned La Jolla since August 2022, and Paion holds the EU authorisation.
What it's used for
A prescription intravenous infusion in intensive care, to raise blood pressure in adults with septic or other distributive shock.
How does Angiotensin II (Giapreza) work?
What it does in the body, and where.Angiotensin II supplies the final hormone of the body's own blood-pressure system directly.
- 01The missing linkNormally renin makes angiotensin I and ACE converts it to angiotensin II. In distributive shock that system struggles; giving angiotensin II directly skips the conversion step.
- 02Squeezing vesselsIt binds AT1 receptors on blood-vessel muscle, narrowing vessels and raising blood pressure, and prompts the adrenal glands to release aldosterone, so the body holds on to salt and water.
- 03Switched off fastEnzymes (aminopeptidase A and ACE2) break it down to angiotensin III and angiotensin-(1-7); the half-life is under a minute, so doses can be changed every 5 minutes. ACE inhibitors and ARBs, common blood-pressure tablets, work by blocking this same system.
A schematic of the compound's mechanism, not a diagnostic image.
What else is it used for?
Each group carries its own evidence level.Approved means regulators have cleared it for that purpose. Investigational means it is in trials. Early research means it is being studied and is not established.
ATHOS-3
FDA-approved- Human trial321 treated patients: blood pressure response at 3 hours in 69.9% against 23.4%, with a median time to target of about 5 minutes.
- Human trialSerious adverse events 60.7% against 67.1%.
- No dataDay-28 deaths 46% against 54% were not statistically different, and the trial was not designed to test survival.
Children
Investigational- No dataAn open-label paediatric study completed with only 2 patients, and a placebo-controlled one has had unknown status since 2018; no efficacy result exists in children.
'ATHOS-3 enrolled 321' is loose: 344 were randomised and 321 received the drug. The 46% against 54% death rate is often read as a survival benefit, but the confidence interval crosses 1 (P=0.12) and the trial was not powered for it. The clot rate appears as 13% against 5% and as 12.9% against 5.1%; they are the same data. The half-life is under a minute, not 'a few minutes'. FDA approval was on 21 December 2017. La Jolla remains the US holder of record but has been owned by Innoviva since 2022; Paion holds the EU authorisation. Angiotensin II and dihexa, a research compound built from angiotensin IV, are different molecules in the same family.
The published record
Papers and trials about Angiotensin II (Giapreza)
354 papers tagged human · 149 not reviews or lab · 23 clinical trial publications
291 registered trials · 14 with posted results
Furthest stage reached: Approved in the US
Counted from Europe PMC indexing, not read by a person; a human tag can land on reviews, commentary or lab papers; clinical trial publications is the narrower count. 446 papers and 100 trials indexed in detail.
At a glance
Four things to know about Angiotensin II (Giapreza)
Evidence
FDA-approved
Category
Sexual and hormonal
Common vial
Varies
Half-life
Under 1 minute
How much, and do you cycle it?
The range, and whether you take breaks.20 ng/kg/min to start, adjusted every 5 minutes (label), continuous infusion, adjusted to blood pressure. Continuous until the shock resolves FDA label
Run continuously and turned down every 5 to 15 minutes as blood pressure recovers, then stopped.
How long does it stay in the body?
The half-life, and where the figure comes from.Under 1 minuteFDA label
Broken down by aminopeptidase A and ACE2 to angiotensin III (about 40% of the pressor activity) and angiotensin-(1-7). Clearance does not depend on the kidneys or liver.
Source: Giapreza US prescribing information, section 12.3
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How is it given?
Dosing context and source notes.Start at 20 ng/kg/min by continuous intravenous infusion, adjusted as often as every 5 minutes in steps of up to 15 ng/kg/min to reach the target blood pressure. No more than 80 ng/kg/min in the first 3 hours or 40 ng/kg/min for maintenance; doses as low as 1.25 ng/kg/min may be used. Diluted in saline to 5,000 or 10,000 ng/mL from 0.5 or 2.5 mg/mL vials. In ATHOS-3 the median dose at 30 minutes was 10 ng/kg/min. Intensive-care use only.
How do you store it?
Before mixing, and after.Given in hospital or a trial clinic, so the pharmacy stores it.
Angiotensin II (Giapreza) goes into a vein and is prepared by hospital, clinic or trial pharmacy staff, following the product label or the trial protocol. Some products like this are ready-made solutions and others are powders mixed just before use, often with hours rather than weeks of shelf life once prepared. It is not a medicine people store at home.
What are the side effects and cautions?
Known cautions and warnings for this compound.Solubility, computed: 50% charged residues, 50% hydrophobic. Water usually sufficient.
A first-pass rule from peptide manufacturers' guidance. It does not account for disulfide bridges, salt form or how the powder was dried, and it predicts what should be easy rather than what will happen in your vial.
Who should avoid it
- The US label lists no contraindications; the EU limits it to shock that persists despite fluids and other vasopressors
- Children: not established; a paediatric study enrolled only 2 patients
- ACE inhibitors may strengthen its effect, and angiotensin receptor blockers weaken it
- Pregnancy: data are too limited, though leaving shock untreated is itself dangerous
Stop and get help
- Signs of a blood clot: a swollen, painful leg, sudden breathlessness, or a cold, pale limb
- Blood pressure rising too high: the infusion is turned down, and the effect fades within minutes
Common effects
- Arterial or venous clots 12.9% against 5.1%, including deep vein thrombosis 4.3% against 0%
- Low platelets 9.8% against 7.0%, and fast heart rate 8.6% against 5.7%
- Fungal infection 6.1% against 1.3%, delirium 5.5% against 0.6%, and acidosis 5.5% against 0.6%
- High blood sugar 4.3% against 2.5%, and reduced blood flow to fingers or toes 4.3% against 2.5%
Where this page says nothing is established, that means nobody has studied it, not that a compound is safe.
Is Angiotensin II (Giapreza) approved?
And where the numbers on this page come from.Yes. Angiotensin II (Giapreza) is FDA approved and available on prescription in the United States. It is also approved in the European Union.
- Approval statusFDA-approved
- RouteInto a vein (continuous infusion, ideally through a central line)
- Checked15 October 2026
- Approved outside the USEuropean Union: EU authorisation as Giapreza on 23 August 2019 (Paion Pharma) for refractory hypotension in septic or other distributive shock, under additional monitoring. Also approved in the US.This does not change the United States position above.
- DoseFrom the drug label. The manufacturer tested this range and a regulator reviewed it.
- Vial sizeFrom what vendors typically list; not a recommendation.
- SourcesGiapreza US prescribing information (DailyMed)Drugs@FDA, NDA 209360Khanna A et al., New England Journal of Medicine 2017;377:419-430 (ATHOS-3)ClinicalTrials.gov, ATHOS-3 (NCT02338843)ClinicalTrials.gov, paediatric study (NCT03431077)ClinicalTrials.gov, placebo-controlled paediatric study (NCT03623529)EMA, Giapreza EPAREMA paediatric investigation plan decision P/0415/2023La Jolla Pharmaceutical 10-Q (June 2022)Innoviva completes La Jolla acquisition (SEC exhibit, 22 Aug 2022)Drugs.com, generic Giapreza availabilityFDA GSRS substance record, angiotensin II acetate (UNII 31L3HS630A)
What has happened recently
FDA-approved on 21 December 2017 (NDA 209360, priority review) to raise blood pressure in adults with septic or other distributive shock; a 0.5 mg/mL strength was added later. The EU authorised Giapreza on 23 August 2019 for refractory hypotension in that setting, held by Paion Pharma. The FDA approved a generic from Gland Pharma on 3 June 2025 following a patent challenge; Drugs.com lists it as not commercially available. Innoviva bought La Jolla Pharmaceutical, the US holder, on 22 August 2022. An EU paediatric investigation plan was due to finish in March 2026; no paediatric approval has been confirmed.
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What else is like Angiotensin II (Giapreza)?
Others in Sexual and hormonal, side by side.If you're weighing Angiotensin II (Giapreza), it's worth reading Atosiban (Tractocile), Cabergoline, and Carbetocin (Pabal, Duratocin) in the same class.
A synthetic copy of the 8-residue hormone angiotensin II. FDA-approved in 2017 for shock that persists despite fluids and other drugs.
- Dose
- 20 ng/kg/min to start, adjusted every 5 minutes (label)
- How often
- Continuous infusion, adjusted to blood pressure
A modified oxytocin that blocks oxytocin and vasopressin receptors on the womb. EU-approved since 2000; a 2025 placebo trial found no benefit for babies.
- Dose
- 6.75 mg bolus, then 300 and later 100 mcg/min for up to 48 hours (EU label)
- How often
- One course of up to 48 hours
A prolactin drug whose label asks for an echocardiogram before the first dose.
- Dose
- 0.25 up to 1 mg per dose, twice a week
- How often
- Twice a week
A modified oxytocin with a carbon-sulfur ring that keeps the womb contracted for hours after one injection. Matched oxytocin in a 29,645-woman trial.
- Dose
- 100 mcg once, after the baby is delivered (label)
- How often
- Once
Guides for this compound
- How to Reconstitute a Peptide
Mix peptide powder with bacteriostatic water, step by step.
- How to Read an Insulin Syringe
Read the units, convert to millilitres, and draw the exact dose.
- mcg vs mg: The Peptide Dosing Mistake to Avoid
Your vial says mg and your protocol says mcg. Here is the conversion and how to check it.
Sources
- Giapreza US prescribing information (DailyMed)(2026)Indication, dosing and titration; sequence DRVYIHPF; half-life under 1 minute; clots 13% against 5%; side-effect table; ATHOS-3 results.
- Drugs@FDA, NDA 209360(2026)Approved 21 December 2017 as a new molecular entity with priority review.
- Khanna A et al., New England Journal of Medicine 2017;377:419-430 (ATHOS-3)(2017)344 randomised, 321 treated: target blood pressure 69.9% against 23.4% (odds ratio 7.95); day-28 deaths 46% against 54% (hazard ratio 0.78, P=0.12).
- ClinicalTrials.gov, ATHOS-3 (NCT02338843)(2018)Phase 3, completed, 344 enrolled; results posted January 2018.
- ClinicalTrials.gov, paediatric study (NCT03431077)(2018)Open-label phase 2 in children completed with 2 patients enrolled.
- ClinicalTrials.gov, placebo-controlled paediatric study (NCT03623529)(2018)Randomised phase 2 in children aged 2 to 17, about 100 planned; status unknown since August 2018; no results.
- EMA, Giapreza EPAR(2024)EU authorisation 23 August 2019 for refractory hypotension in septic or distributive shock; holder Paion Pharma.
- EMA paediatric investigation plan decision P/0415/2023(2023)Paediatric plan from birth to 18 years, due for completion by March 2026.
- La Jolla Pharmaceutical 10-Q (June 2022)(2022)Paion licence (January 2021); Gland Pharma patent challenge and lawsuit; Innoviva merger agreement.
- Innoviva completes La Jolla acquisition (SEC exhibit, 22 Aug 2022)(2022)Acquisition completed at $6.23 a share.
- Drugs.com, generic Giapreza availability(2025)Gland Pharma generic approved June 2025, not commercially available; 0.5 mg/mL strength dated December 2021.
- FDA GSRS substance record, angiotensin II acetate (UNII 31L3HS630A)(2026)Protein-class record for the drug substance.
Beyond these, 546 records are indexed. Browse the records